The Effects of Patient Positioning on the Outcome During Posterior Cranial Fossa and Pineal Region Surgery

Mavarez-Martinez, Ana; Israelyan, L.; Soghomonyan, Suren; Fiorda-Diaz, Juan; Sandhu, Gurneet; Shimansky, Vadim; Ammirati, Mario; Palettas, Marilly; Lubnin, A.Yu.; Bergese, Sergio D.

doi:10.3389/fsurg.2020.00009

Cited by 13 publications

(8 citation statements)

References 32 publications

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“…Supratentorial tension pneumocephalus can be evacuated through a frontal cannulation in order to replace the air by water [6] , [8] . For posterior fossa pneumocephalus, surgical approaches are more controversial.…”

Section: Discussionmentioning

confidence: 99%

“…This complication is widely reported in the follows of a posterior fossa surgery performed in the sitting position [3] , [5] . The occurrence of compressive pneumocephalus after a posterior fossa craniotomy performed in a prone position is very rare [6] . We report the case of a young patient who developed brain-stem tension pneumocephalus in the early postoperative course after posterior fossa craniotomy for a medulloblastoma in prone position responsible for a clinical deterioration.…”

Section: Introductionmentioning

confidence: 99%

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Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?

Gader

Rkhami

Daghfous

et al. 2022

International Journal of Surgery Case Reports

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Introduction The term pneumocephalus refers to the existence of air in any intracranial compartment. Its presence in the follows of a supratentorial craniotomy is very common, and it usually represents a benign complication as it is very rarely responsible for clinical manifestations. Case presentation We report the case of a 24 years-old man, who underwent posterior fossa surgery in prone position for resection of a vermian tumor. Postoperative, the patient presented a tonic-clonic generalized seizure associated to high levels of arterial pressure and decerebration. Control CT scan showed an important pneumocephalus. On the posterior fossa, the air was responsible for a compression of the brainstem, without any other postoperative complications. Following 12 h of conservative management, a brain MRI showed a total regression of the pneumocephalus. 3 days later, the patient presented a favorable outcome as he was extubated without any major impairments. Discussion Transformation of pneumocephalus into tension pneumocephalus responsible for clinical inadvertance is rare. This complication is mainly related to surgeries performed in sitting position. The occurrence of compressive pneumocephalus after a posterior fossa craniotomy performed in a prone position is seldom. Conclusions Through this case, we discuss pathophysiology and therapeutic approaches for tension pneumocephalus following posterior fossa performed in prone position.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?

Gader

Rkhami

Daghfous

et al. 2022

International Journal of Surgery Case Reports

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“…Stillman (11) describes development of macroglossia in an infant after using an inappropriately large LMA. Patient positioning during surgery can also predispose to development of macroglossia, which will be difficult to differentiate from AE (4,8,(11)(12)(13)(14). In such situations, mechanical trauma related to airway manipulation and impaired venous and lymphatic drainage play a role, and, usually macroglossia is evident immediately upon completion of surgery.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Post-operative Angioedema After a Laryngeal Mask Airway Application

2021

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Angioedema with macroglossia is a rare complication of anesthesia. We present a clinical case of post-operative development of angioedema presenting as macroglossia in a patient receiving chronic therapy with lisinopril, who developed symptoms in the early post-operative period following surgery in a lateral position, when a laryngeal mask airway was used. Possible mechanisms of angioedema and macroglossia development in our patient are discussed along with potential underlying predisposing mechanisms and available therapeutic approaches.

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“…There seem to be no special patient-dependent risk factors for air embolism and the semi-sitting patient positioning appears not to influence complication rates of posterior fossa surgery [ 39 ]. Other analyses even show less surgical complications, such as bleeding, aside from air embolism for the semi-sitting position [ 41 , 43 ].…”

Section: Surgerymentioning

confidence: 99%

Medulloblastoma in adults – reviewing the literature from a surgeon’s point of view

Eibl

Hammer

Yakubov

et al. 2021

Aging

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Medulloblastoma is a common primary brain tumor in children but it is a rare cancer in adult patients. We reviewed the literature, searching PubMed for articles on this rare tumor entity, with a focus on tumor biology, advanced neurosurgical opportunities for safe tumor resection, and multimodal treatment options. Adult medulloblastoma occurs at a rate of 0.6 per one million people per year. There is a slight disparity between male and female patients, and patients with a fair skin tone are more likely to have a medulloblastoma. Patients present with cerebellar signs and signs of elevated intracranial pressure. Diagnostic efforts should consist of cerebral MRI and MRI of the spinal axis. Cerebrospinal fluid should be investigated to look for tumor dissemination. Medulloblastoma tumors can be classified as classic, desmoplastic, anaplastic, and large cell, according to the WHO tumor classification. Molecular subgroups include WNT, SHH, group 3, and group 4 tumors. Further molecular analyses suggest that there are several subgroups within the four existing subgroups, with significant differences in patient age, frequency of metastatic spread, and patient survival. As molecular markers have started to play an increasing role in determining treatment strategies and prognosis, their importance has increased rapidly. Treatment options include microsurgical tumor resection and radiotherapy and, in addition, chemotherapy that respects the tumor biology of individual patients offers targeted therapeutic approaches. For neurosurgeons, intraoperative imaging and tumor fluorescence may improve resection rates. Disseminated disease, residual tumor after surgery, lower radiation dose, and low Karnofsky performance status are all suggestive of a poor outcome. Extraneural spread occurs only in very few cases. The reported 5-year-survival rates range between 60% and 80% for all adult medulloblastoma patients.

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The Effects of Patient Positioning on the Outcome During Posterior Cranial Fossa and Pineal Region Surgery

Cited by 13 publications

References 32 publications

Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?

Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?

Case Report: Post-operative Angioedema After a Laryngeal Mask Airway Application

Medulloblastoma in adults – reviewing the literature from a surgeon’s point of view

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